The present invention relates to a composition and method of prophylaxis and treatment for oral mucosal lesions. Oral lesions of various forms may develop in many circumstances and conditions. These forms of oral lesions include, for example, ulcerations, infections, stomatitis and vesiculo-bullous lesions. Among the most acute of these oral lesions are those typically occurring as an incident to cancer chemotherapy. These chemotherapy-related lesions may be so painful and severe as to force cessation of the chemotherapy, as well as eating and drinking, which may interfere with medical treatment. The lack of a consistent, effective and convenient method of prophylaxis and treatment for such oral lesions has too long been a therapeutic handicap.
Certain antineoplastic drugs have well documented direct and indirect stomatotoxicity. The direct toxicity is characterized by the interruption of the migrating, maturing squamous cells from the basal cell layer to the oral mucosal surface. As this normal progression is attenuated and desquamation of surface cells continues, it may be clinically manifested as oral mucosal ulcerations. Acute and severe pain may be associated with this ulcerative process at it's developmental peak. Patients have discontinued their chemotherapy due to this complication. Such cessation means that the full chemotherapy protocol cannot be delivered and thus, the patient may not be provided the best therapeutic effect. Control or cure of the cancer may be lost. The patient and family are then placed in an emotional struggle between gaining relief from the oral pain and simultaneously realizing that in doing so the cancer may continue to progress.
The indirect stomatotoxic effects are related to alteration of the hematologic status through myelosupression and the patient's subsequent decreased ability to resist infections and hemorrhage. Oral infections increase the overall morbidity of cancer chemotherapy. If these infections are not discovered early and treated aggressively, they may be lethal following their systemic dissemination. Oral hemorrhaging may occur spontaneously and be profuse. Such incidents are terribly distressful to the patient, family and the professional care team. Fatal exsanguination has been reported.
Currently, antineoplastic drug therapy is being used with 40% of cancer patients either as a single treatment modality or as part of multi-modal therapy (chemotherapy, surgery, radiation). Some cancers respond well to single agent chemotherapy and others are treated with several agents in combination. New combinations and single agents are used in investigational clinical trials. The oral toxicity must be identified for all of these new agents and new combinations. Data show that nearly 50% of all individuals receiving chemotherapy will develop oral complication. These complication include stomatitis, infection and hemorrhage. Of this 50% incidence rate, 33% will develop one complication, 10% two complications and 3-4% will develop all three.
There is a plethora of scientific reports describing the multiple and varied oral complications as sequelae to cancer chemotherapy. Great detail has been used to describe these clinical entities. To a lesser degree, the scientific literature offers explanations for the pathogenesis of these oral lesions. Treatment protocols for these sequelae are more sparse and varied. Their development seems to be more empiric than scientific. An extensive literature search and a preliminary survey of some of the major cancer treatment centers in North America indicate that no treatment is presently available to prevent or significantly attenuate these oral complications. Clearly, there is a need for a proven, safe, comfortable and effective method and material to address this widespread and difficult problem.